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bodhisattvya
IV site prep;(alcohol wipes vs. chlorhexidine vs. povo-iodine preparation.)

I work at a small rural hospital & I am trying to convince my nurse manager that we should use something other than alcohol wipes for IV site prep. I have been given the hint that the price of Chlorhexidine is prohibitive. At my previous work place we used B&D's Persist prior to switching over to Chlorhexidine. Am I correct in assuming the INS standard of care is Chlorhexidine? If so is Persist or a similar povo-iodine product an acceptable & more cost-effective alternative. If anyone has any literary references, I would greatly appreciate it.

Toby Knight-Meigs,RN,BSN,EMT-P,RRT

Staff Nurse in Western Oregon

 

lynncrni
According to the CDC

According to the CDC guidelines, chlorhexidine gluconate is preferred but they do state that alcohol and povidone-iodine are acceptable. IHI also prefers chlorhexidine. INS has language similar to CDC - chlorhexidine preferred. Persist is a combo product of alcohol and povidone-iodine. Chloraprep and Chlorascrub are also combo products of chlorhexidine and alcohol. I am assuming you are talking about skin antisepsis prior to insertion of a short peripheral catheter. For insertion of all CVCs, there is a strong trend toward chlorhexidine based on published studies with better outcomes. With reimbursement for hospital acquired BSI going away in Oct 08, I think most hospitals are sticking to what works best. Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

IVRN
Even the blood banks

Even the blood banks (www.aabb.org)  are using chlorohexidine now before access for blood donation, and that IV only stays in 1 hour or less!

There are many articles showing the advantages of chlorohexidine over alcohol alone or alcohol and iodine. 

MacMillan S.

Could you please comment regarding the use of iodine alcohol, 70% isopropyl alcohol and tincture of chlorohexidine in cleaning of silicone central venous catheter insertion sites and hubs.

Can J Infect Control. 1993 Autumn;8(3):81. No abstract available.
PMID: 8251656 [PubMed - indexed for MEDLINE]
Maki DG, Ringer M, Alvarado CJ.
Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.
Lancet. 1991 Aug 10;338(8763):339-43.
PMID: 1677698 [PubMed - indexed for MEDLINE]
Kasuda H, Fukuda H, Togashi H, Hotta K, Hirai Y, Hayashi M.
Skin disinfection before epidural catheterization: comparative study of povidone-iodine versus chlorhexidine ethanol.
Dermatology. 2002;204 Suppl 1:42-6.
PMID: 12011520 [PubMed - indexed for MEDLINE]
There are more, search for chlorohexidine and catheter on Pubmed
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